MRI with diffusion-weighted imaging to predict feasibility of complete cytoreduction with the peritoneal cancer index (PCI) in advanced stage ovarian cancer patients

M. P. Engbersen, Jetske van' t Sant, C. Lok, D. M. J. Lambregts, G. S. Sonke, R. G. H. Beets-Tan, W. J. van Driel, M. J. Lahaye*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: To determine the diagnostic performance of MRI with diffusion-weighted imaging (DW-MRI) in assessing the peritoneal tumor load and predicting whether a complete cytoreduction can be achieved in patients with epithelial ovarian cancer (EOC).

Methods: For this observational prospective study, 25 patients with epithelial ovarian cancer scheduled for cytoreductive surgery were included. Patients underwent a 3 T DW-MRI scan prior to surgery. The MR protocol consisted of a T1 and T2 weighted, a contrast-enhanced T1 weighted, and a diffusion-weighted (b0, b1000) sequence. The Peritoneal Cancer Index (PCI) was determined on DW-MR images (MRI-PCI) by two readers, independently, and was compared to the PCI determined during surgery (S-PCI). The inter-observer agreement between the two radiologists was evaluated. In addition, receiver operating characteristics curves were calculated for predicting complete cytoreduction with the S-PCI and MRI-PCI.

Results: Staging with DW-MRI showed a correlation to surgical staging with an intraclass correlation coefficient (ICC) 0.86 and 0.85 for reader 1 and 2, respectively. Inter-observer agreement was excellent with an ICC of 0.90 (95% CI: 0.64-0.96). The MRI-PCI scores of reader 1 (AUC = 0.96), reader 2 (AUC = 0.98), and the S-PCI (AUC = 0.92) showed similar predictive values for complete cytoreduction.

Conclusion: DW-MRI is accurate in predicting the S-PCI and can be helpful to predict whether a complete resection in ovarian cancer patients is feasible.

Original languageEnglish
Pages (from-to)146-151
Number of pages6
JournalEuropean Journal of Radiology
Publication statusPublished - May 2019


  • Cytoreductive surgery
  • Diffusion-weighted MRI
  • Advanced-stage ovarian cancer
  • Peritoneal carcinomatosis
  • CT

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